Student Portfolio
This portfolio can be completed by the student, their family and/or educational personnel.
It is designed to provide important student information to new service providers in a
concise, easy to read summary. It is not meant to replace required medical or educational
documents. Not all parts of the portfolio will be necessary or appropriate for all students.
In addition to the written information provided, it may be helpful to include photographs
of the student at school, work and home, photos of the student using particular assistive
devices, photos of any unique communication systems the student uses, or videotapes of
these same activities and devices.
The information in the portfolio is CONFIDENTIAL and should be appropriately
protected.
This portfolio was originally adapted by the South Dakota Deafblind Project from:
“Could you please tell my new teacher?” Demchak and Elmquist, Nevada Dual Sensory Impairment
Project, 2001
Home Talk, A family assessment of children who are deafblind. Mar, Roland, Schweigert. Oregon
Institute on Disability and Development, 2002
TRANSITION PORTFOLIO
My Name: ___________________________
My Age: ________________
MY VISION AND HEARING
Vision
I wear glasses.
I do not wear glasses.
This is the name of my visual impairment: _____________________________________
Without my glasses I can see:
With my glasses I can see:
These are the modifications I use in my classroom:
Hearing:
I wear hearing aids
___ right ear ___ left ear
I do not wear hearing aids
I have a cochlear implant (date of implantation
I use an assistive listening device
)
_____ FM system ____Infrared system
This is the level of my hearing loss in decibels:
500 Hz
Right Ear
Left Ear
1000 Hz
2000 Hz
4000 Hz
MY MEDICAL INFORMATION
In addition to my vision and hearing losses, I have the following medical conditions.
1. Name of condition:
How it affects me
Name of my physician
2. Name of condition:
How it affects me
Name of my physician
3. Name of condition:
How it affects me
Name of my physician
4. Name of condition:
How it affects me
Name of my physician
Medications I take on a regular basis:
MY COMMUNICATION METHODS
I use spoken words to communicate: Yes
No
_____My words might be hard to understand, please listen to me closely
_____I can put ____________# of words together when I talk to you
_____I can use some complete sentences to talk with you.
_____I need _______ (# of seconds) before I can respond to you
Here are some ideas to increase my understanding of what you say to me:
I use sign language to communicate:
Yes
No
_____My signs might be hard to understand, please watch my signs closely
_____I can put ___________# of signs together to communicate with you
_____I can use some complete sentences to sign to you
_____I need __________ (# of seconds) before I sign back to you
Here are some ideas to increase my understanding of what you sign to me.
Sometimes I use objects to tell others what I want. Yes
No
These are the objects and the communicative meaning that I use:
Object
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
N/A
Communicative Meaning
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
When others give me objects, it helps me understand what is going to happen to me or
around me. Yes
No
N/A
These are the objects and communicative meanings that I use:
Object
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Communicative Meaning
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Sometimes I use gestures to communicate:
____ I nod my head yes
____ I shake my head no
____ I point to things I want
____ I use other gestures:
Gesture
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Yes
No
N/A
Communicative Meaning
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
I use photos/line drawings to communicate:
Yes
No
I have a dictionary of photos/line drawings I keep with me
N/A
Yes
No
N/A
Here are some examples of the photos I use:
Sometimes I use ways of communicating that are not always seen as communication by
others but are my only way to tell others what I want or how I feel. Yes
No
N/A
Some of these are:
Behavior
Crying
Aggression
Tantrums/Self Injury
Eye Gaze
Proximity
Pulling Other’s Hands
Touching/Moving Other’s Face
Grabbing/Reaching
Walking Away
Vocalization/Noise
Facial Expressions
Other ____________
What it means__________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
I use a voice output device to help me communicate
Yes
No
The device is called ____________________________________________________
Ways to help me use my voice output devices:
MY ADAPTIVE EQUIPMENT
For mobility, I use
___ A wheelchair
___ A walker
___ A white cane
___ Braces or orthotics
___ Other: ________________________________________________________
I have received Orientation and Mobility Training Yes
No
Name of Agency / O&M instructor __________________________________________
_______________________________________________________________________
I use the following assistive technology at home and school:
___Telephone amplification equipment
___ TTY
___ Braille
___ Large Print
___ Adaptive Writing Instruments
I use the following assistive technology for the computer:
I use the following adaptive equipment for recreation or other activities:
I have a physical therapist
Yes
No
Name: ____________________________________________
Agency: ___________________________________________
I have an Occupational Therapist Yes No
Name: ____________________________________________
Agency: ___________________________________________
WHAT I LIKE
These are some of my strengths and talents:
These are some of my favorite activities:
Some jobs I can do around the house, or at school, or in the community are:
These are some of the important people in my life:
WHAT I DON’T LIKE
These are some things that are difficult for me:
These are some activities I don’t like to do:
These things make me upset (activities, items, people)
These things make me anxious or frightened (activities, items, people)
Behaviors I display when I’m
Angry: ____________________________________________________
Bored: ______________________________________________________
Upset: ______________________________________________________
Lonely: ______________________________________________________
Sad:
_______________________________________________________
Sick: ________________________________________________________